Enhancing Kidney Supply Through Geographic Sharing in the United States

43 Pages Posted: 30 Jun 2017

See all articles by Mazhar Arikan

Mazhar Arikan

University of Kansas, School of Business

Baris Ata

University of Chicago - Booth School of Business

John Friedewald

Northwestern University - Feinberg School of Medicine

Rodney P. Parker

Indiana University Bloomington

Date Written: May 8, 2017

Abstract

The deceased-donor kidney allocation system suffers from a severe shortage of available organs. We illustrate a mechanism which can increase the supply of cadaveric kidneys in the United States. This supply increase exploits the fact that under the current kidney allocation policy, some kidneys remain unprocured in some procurement areas but would be highly sought in other areas. The current kidney allocation policy procures within a Donor Service Area (DSA) and offers these kidneys first to patients in the DSA; if these offers are not accepted, the kidney will be offered within the region (a cluster of DSAs); if these offers are not accepted, the kidney will be offered nationally. A deceased-donor organ is procured if there is the belief that the offered organ will be transplanted (known as "intent"). We conduct an empirical analysis of the donor and recipient data (at the DSA level) which reveals that the intent increases significantly with organ quality, the median waiting time for a transplant, and higher competition. In particular, it shows that lower quality organs are likely to be procured at a higher rate in DSAs with longer waiting times. Motivated by a new kidney allocation system, we conduct a counterfactual study which shows that geographically broader sharing the bottom 15% quality kidneys leads to stronger intent for the organ. The stronger intent results in an increase in the procurement rates of those organs, thus increasing the supply of procured organs available for transplantation. In particular, the regional sharing of those organs leads to an expected 58 additional procured kidneys per year (3.3% supply increase among the bottom 15% quality kidneys), whereas the national sharing results in an expected 129 additional kidneys per year, increasing the supply of the bottom 15% quality kidneys by 7.3%. We also propose a variation of the new policy that increases the quality threshold to the lowest 20% quality, which results in an even greater increase of the supply than from the current policy. Our analysis shows that this new threshold policy leads to an expected 174 additional kidneys procured per year with national sharing.

Keywords: kidney transplantation, discrete choice model, game theory, control function approach

Suggested Citation

Arikan, Mazhar and Ata, Baris and Friedewald, John and Parker, Rodney P., Enhancing Kidney Supply Through Geographic Sharing in the United States (May 8, 2017). Available at SSRN: https://ssrn.com/abstract=2994612 or http://dx.doi.org/10.2139/ssrn.2994612

Mazhar Arikan (Contact Author)

University of Kansas, School of Business ( email )

Lawrence, KS 66045
United States

Baris Ata

University of Chicago - Booth School of Business ( email )

5807 S. Woodlawn Avenue
Chicago, IL 60637
United States

John Friedewald

Northwestern University - Feinberg School of Medicine ( email )

Chicago, IL 60611
United States

Rodney P. Parker

Indiana University Bloomington ( email )

1309 E 10th Street, HH4129
Bloomington, IN 47405
United States

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